Teri Touchstone has a lot on her plate as mom to three active teens. She volunteers at their schools, as well as with community charities, and drives all three kids to their numerous extracurricular activities. But, on top of all that, the Gladwyne wife and full-time mother also has had to care for her 100-year-old grandmother, Jean Gordon, who has vision and hearing problems, is on oxygen 24 hours a day and has several other health ailments.

Though Touchstone has two brothers and lots of extended family, she said her grandmother's care all fell on her at first.

"[My kids] go to school; I go to bubby," said Touchstone, 44. "It's a juggling act, with a lot going on, but you make things work."

She knows she's fortunate that her grandmother only lives a few miles away in Bala Cynwyd, and that her husband, Andy, an attorney, is "so understanding."

The term coined to describe situations such as Touchstone's -- "the Sandwich Generation" -- encompasses the feeling of being squeezed between responsibilities: caring for aging or sick parents, or even older relatives, at one end, while also raising children.

It's estimated that $306 billion is spent on family caregiving per year in the United States, according to the National Alliance for Caregiving, a nonprofit coalition of U.S. groups that focus on family care. More than 44 million family members are currently caring for an aging loved one, reported the alliance, and nearly 60 percent of these individuals work outside the home, and 40 percent of caregivers have children under the age of 18. The Pew Research Center reports that just over one in eight Americans, age 40 to 60, is both raising a child while simultaneously caring for a parent.

Furthermore, statistics from the U.S. Census Bureau indicate that the number of older Americans -- ages 65 and up -- will double by the year 2030, to more than 70 million people.

The Pool's Shrinking
With nearly one in four Jews over the age of 60 -- and a declining Jewish birthrate -- the result is a smaller pool of caregivers, commented Rabbi Dayle A. Friedman, director of Hiddur: The Center for Aging and Judaism at the Reconstructionist Rabbincal College in Wyncote. This is "why we're seeing more cases of grandkids" -- like Touchstone -- "taking care of grandparents."

And there are still a lot of "people out there who are caregivers but don't realize they are," added Friedman, whose newest book, Jewish Visions for Aging: A Professional Guide for Fostering Wholeness, was released in September.

"It's not just one 'sandwich' anymore," said Friedman, "and people are waking up to the fact that caregivers need care themselves and support from the Jewish community."

One of the Lucky Ones
Despite all she has to cope with, Touchstone knows, fundamentally, that she's lucky. When her grandmother started to have balance problems and began falling on occasion, "we insisted she get help, live-in care," recalled her granddaughter.

And Gordon could afford it.

Touchstone sought assistance from Griswold Special Care, a nonmedical, home-care company based in Erdenheim that has 100 offices nationally and internationally, which located an aide who could tend to Gordon 24/7.

Since April 2006, Gordon has been assisted by Gladys Tezera, 32, who sleeps in a room adjacent to the master bedroom, listening for the bell that signals when she's needed. She gets Gordon up, helps her dress, makes her meals, feeds and bathes her, and takes her wherever she needs to go, whether it's to her biweekly hairdresser appointments or for checkups with the doctor.

"When Gladys came on board, I was able to step back, and just be a granddaughter," said Touchstone, who still visits her grandmother regularly to go through the mail, handle her bills and sort her medicine.

"It's Gladys who makes my life livable," she continued. "I trust her -- she wants to do what's best for my grandmother."

Renee Davidow hasn't been as lucky as Touchstone. She and her husband couldn't afford help, so Davidow's mother-in-law, Adele Carchman, 88, moved into the family's Cherry Hill, N.J., home 11 years ago. Davidow's sons, Benjamin, Danny and Rob, were teenagers when their grandmother moved in, and had to adjust further when the family needed to move "to a more-accommodating house," noted Davidow, with a studio-like apartment on the first floor for Carchman.

But Davidow, 52, doesn't just live the Sandwich Generation life -- she works it, too. During the day, she is director of community relations for Lions Gate, a glatt-kosher, Jewish Federation of Southern New Jersey-affiliated, continuing care, retirement community in Voorhees.

How Do People Do It?
Davidow cooks her mother-in-law's meals, takes her shopping and to doctor's appointments. For right now, Carchman stays in the house all day while her son, Evan, and daughter-in-law are at work, and stays with one of her other children when the family goes on the occasional vacation.

So how do people manage with this push-me-pull-me life?

Fiona Middleton, vice president of Griswold, noted that families living the Sandwich scenario are, all too often, unaware of support services and options available to them, whether they need a break for an afternoon, or round-the-clock live-in care, such as what Touchstone secured for her grandmother.

Mary Mullen, director of the Philadelphia Corporation for Aging's Family Caregiver Support Program, noted that her division also works to direct families to community resources, such as adult-day-care centers, aide assistance and support groups, but it also provides financial suggestions, such as where to find reimbursement for medical supplies that can sometimes cost hundreds of dollars per month, or recommendations for household assistance items, such as grab bars for bathtubs or a chair lift.

The Philadelphia area has a variety of other resources available to help caregivers in multiple facets. Licensed clinical social worker Patty Rich said the staff at the Abramson Center for Jewish Life's Counseling for Caregivers puts the focus on caregivers to make sure that they're coping, and especially are making time to care for their own physical and mental health.

Caregiving "is often a thankless job," and the individual providing the care "needs someone to acknowledge the work they are doing," noted Rich. Caring for a loved one is like a job, only you don't always "have concrete efforts to show for your work." But Rich also pointed out that while much of caregiving is hard, people can receive a lot of fulfillment from "knowing they are caring for someone who once took care of them."

Susan Goldberg Smith, director of the Time Out Respite Program in the Center for Intergenerational Learning at Temple University, explained that in-home respite services allows the caregiver to have an "essential" and "much-needed break" from the sometimes-overwhelming stressors of caring for an elderly loved one.

The program connects college students, usually those in medical-related majors from area colleges, with families in Philadelphia seeking help at a low cost. Such programs "help the elderly stay in their home longer," explained Smith, while reducing the stress and isolation for the caregiver and his or her family, who "can look forward to that scheduled break."

One Jewish caregiver being helped by Time Out is Barbara Chadwin, 73, of Center City, who takes care of her mom, Elaine Yoblick, 96.

"Someone has to be with her 24/7," said Chadwin, citing her mom's multiple health issues, ranging from lung ailments to easy bruising. While an aide does come in two times per week to help bathe her mom, and a nurse drops by once a week for a medical check, Chadwin is still the primary caregiver.

Chadwin said her family encouraged her to seek a break from the constant caregiving, and when she found a flyer for Time Out, she knew she had found the right program. Smith matched Yoblick up with Lisa Williams, a junior social work major, who helped Chadwin out about two days a week during this past spring and summer, mostly during the daytime, but for a few evenings as well.

At first, "I felt guilty for leaving my mom, but I needed to get out," explained Chadwin, "and my mom wants me to be able to do things. The Time Out program is great for me."

Advice From a Pro
Davidow advises others who have an aging or sick older parent to discuss care issues, as a family, before it gets to "an extreme situation." While addressing safety concerns "might be met with a state of denial" as to how bad the present situation is, "you have to tell your emotional side that a change is necessary," and that assisted living, skilled nursing care or live-in help is needed.

She said she knows that her current situation is "not for everyone"; and she also understands that eventually she'll have to seek more care for her mother-in-law.

"It's very hard," sighed Davidow. "Even when everything's perfect, it's hard. We are all busy. We all have our own lives, but my husband and I made a commitment to my mother-in-law. We do what we have to do.

"I definitely do not regret the decision I made," said Davidow. "Do I feel overwhelmed and stressed sometimes? Yes. Would I want in any other way? No."